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Relationship between apparent diffusion coefficient and subsequent hemorrhagic transformation following acute
D C Tong1, A Adami, M E Moseley
1Stanford Stroke Center, Palo Alto, Calif, USA. dct@leland.Stanford.edu
Background And Purpose:
A method for identifying patients at increased risk for developing secondary hemorrhagic transformation (HT) after acute ischemic stroke could be of significant value, particularly in patients being considered for thrombolytic therapy. We hypothesized that diffusion-weighted MRI might aid in the identification of such patients.
Methods:
We retrospectively analyzed 17 patients with ischemic stroke who received diffusion-weighted MRI within 8 hours of symptom onset and who also received follow-up neuroimaging within 1 week of initial scan. The apparent diffusion coefficient (ADC) for each pixel in the whole ischemic area was calculated, generating a histogram of values. Areas subsequently experiencing HT were then compared with areas not experiencing HT to determine the relationship between ADC and subsequent HT.
Results:
A significantly greater percentage of pixels possessed lower ADCs (40% of the pixels possessed values
Conclusions:
HT-destined stroke regions possess a significantly great percentage of low ADC values than non-HT-destined regions. Early measurement of ADC values may be a useful tool for assessing secondary HT risk.
Insights
Identifying patients at risk for secondary hemorrhagic transformation (HT) after ischemic stroke is crucial. Diffusion-weighted MRI, specifically apparent diffusion coefficient (ADC) values, can help predict HT development, aiding treatment decisions.
Area of Science:
- Neuroimaging
- Stroke Medicine
- Radiology
Background:
- Secondary hemorrhagic transformation (HT) is a complication after acute ischemic stroke.
- Identifying patients at high risk for HT is vital, especially for thrombolytic therapy.
- Diffusion-weighted magnetic resonance imaging (dMRI) may offer predictive capabilities.
Purpose of the Study:
- To investigate if diffusion-weighted MRI can identify patients at increased risk of secondary HT.
- To explore the relationship between apparent diffusion coefficient (ADC) values and subsequent HT development.
Main Methods:
- Retrospective analysis of 17 ischemic stroke patients with dMRI within 8 hours of onset.
- Calculation of apparent diffusion coefficient (ADC) histograms for ischemic areas.
- Comparison of ADC values in areas that developed HT versus those that did not.
Main Results:
- HT lesions showed a significantly higher percentage of low ADC values (
- All lesions that subsequently developed HT had >40% of pixels with low ADC values.
- Non-HT lesions had <31% of pixels with low ADC values.
Conclusions:
- Stroke regions destined for HT exhibit a significantly greater proportion of low ADC values.
- Early assessment of ADC values using dMRI may serve as a valuable tool for predicting secondary HT risk.